The Senior Medical Billing & Coding Specialist supports and optimizes the organization's revenue cycle operations, focusing on accurate coding, timely billing, and maximizing reimbursement. Requires expertise in FQHC billing methodologies, payer regulations, and coding compliance, with ability to identify trends, resolve complex issues, and support revenue integrity.
Key responsibilities include:
- Perform and review medical coding (CPT, ICD-10, HCPCS) ensuring accuracy and compliance
- Submit and reconcile claims timely to ensure clean claim rates
- Monitor and resolve claim denials, rejections, and underpayments
- Apply knowledge of FQHC billing requirements, including PPS/APM methodologies
- Ensure proper use of encounter billing, modifiers, and sliding fee scale structures
- Support billing for integrated services including primary care and behavioral health
- Analyze accounts receivable reports and aging to identify revenue leakage
- Perform root-cause analysis on denials and implement corrective actions
- Collaborate to improve front-end and back-end revenue cycle processes
- Ensure adherence to HRSA, Medicare, Medicaid, and payer-specific regulations
- Participate in audits and maintain documentation
- Stay current on coding updates and regulatory changes
- Utilize EHR/PM systems like Athena for billing, reporting, and workflow management
- Generate reports for leadership on revenue cycle performance
- Work closely with clinical, administrative, and finance teams to improve documentation and workflows
- Provide guidance and training on coding and billing best practices
Qualifications:
- 3+ years medical billing and coding experience
- Strong knowledge of CPT, ICD-10, and HCPCS coding systems
- Experience with FQHC billing and reimbursement (PPS/APM, encounter billing)
- Proficient with EHR/Practice Management systems (Athena preferred)
- Experience with Medicaid, Medicare, and managed care billing
- Strong analytical and problem-solving skills
Preferred:
- CPC, CCS, or equivalent certification
- Experience in community health or FQHC settings
- Familiarity with behavioral health and integrated care billing
Key Competencies:
- Detail-oriented with strong accuracy in coding and billing
- Analytical mindset able to identify and resolve issues
- Strong communication and collaboration skills
- Ability to manage multiple priorities in a fast-paced environment
Requirements & Qualifications
- Minimum 3 years of medical billing and coding experience
- Strong knowledge of CPT, ICD-10, and HCPCS coding
- Experience with FQHC billing including PPS/APM and encounter billing
- Proficiency with EHR/Practice Management systems such as Athena
- Familiarity with Medicaid, Medicare, managed care billing
- CPC, CCS or equivalent certification preferred
- Experience with behavioral health and integrated care billing preferred
Benefits & Perks
- Medical insurance
- Vision insurance
- Dental insurance
Location
Charlotte, North Carolina, US
Employment Type
Full-time
Experience Level
Senior
Salary Range
$50,000 - $55,000
Remote work allowed
No
Posted
1 month ago